| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
7,433 |
7,109 |
$178K |
| D1110 |
Prophylaxis - adult |
4,890 |
4,636 |
$173K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
825 |
528 |
$85K |
| D0330 |
Panoramic radiographic image |
1,799 |
1,640 |
$78K |
| D0274 |
Bitewings - four radiographic images |
2,711 |
2,516 |
$76K |
| D1206 |
Topical application of fluoride varnish |
4,793 |
4,572 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
4,862 |
4,430 |
$66K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,798 |
2,978 |
$64K |
| D1120 |
Prophylaxis - child |
2,352 |
2,236 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,468 |
1,384 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
993 |
911 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
307 |
219 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
201 |
64 |
$12K |
| D0272 |
Bitewings - two radiographic images |
383 |
365 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
384 |
348 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
27 |
$4K |